若年で発症したintrapapillary hemorrhage with adjacent peripapillary subretinal hemorrhage（IHAPSH）の1例

A case of intrapapillary hemorrhage with adjacent peripapillary subretinal hemorrhage（IHAPSH）occurred at a young age

要約　目的：IHAPSHは，視神経乳頭部の出血と乳頭周囲の網膜下出血を生じる症候群で，近視の女性に多いとされているが^1），10代前半でIHAPSHを生じた報告は少ない。今回筆者らは，若年女児に発症した典型的なIHAPSHの1例を経験したので報告する。

症例：12歳，女児。主訴は右眼の飛蚊症。

所見：初診時の矯正視力は右0.9，左1.2，右眼の視神経乳頭部の出血と乳頭鼻側に網膜下出血，硝子体出血を認めた。視神経乳頭は楕円形で耳側コーヌスがあり近視性の変化を認めた。OCT angiographyやフルオレセイン蛍光眼底造影では，脈絡膜新生血管や視神経乳頭上の新生血管は認めなかった。IHAPSHの診断で経過観察とし，初診から6週間後に視神経乳頭部の出血と乳頭周囲の網膜下出血および硝子体出血はほぼ消失し右矯正視力は1.0に改善した。

結論：本症例は，①視神経乳頭部からの出血，②近視眼，③視神経乳頭の鼻側に網膜下出血，④出血は自然消退する，⑤視力予後は良好，⑥女性，⑦再発がみられない，とIHAPSHに特徴的な所見が揃っており典型的なIHAPSHの症例と考えられた。IHAPSHの報告例はいまだ少ないが，若年の乳頭出血を生じた際の鑑別疾患として念頭に置く必要がある。

Abstract　Purpose：Intrapapillary hemorrhage with adjacent peripapillary subretinal hemorrhage（IHAPSH）is a syndrome associated with intrapapillary hemorrhage and peripapillary subretinal hemorrhage that commonly occurs in myopic women. There are few reports of IHAPSH occurring in teenaged patients. Herein, we report a case of typical IHAPSH that occurs in young girl.

Case：A 12-year-old girl presented with floaters in the right eye.

Findings：Our initial examination revealed a best-corrected visual acuity of 0.9 in the right eye and 1.2 in the left eye. Ophthalmoscopic examination disclosed intrapapillary hemorrhage, nasal peripapillary subretinal hemorrhage, and vitreous hemorrhage in her right eye. She had an oval-shaped optic disc with a temporal conus, indicative of a myopic eye. Optical coherence tomography and fluorescein angiography showed no optic disc and choroidal neovascularization. IHAPSH was diagnosed and the patient was placed on follow up. Six weeks later, the vitreous hemorrhage disappeared. The best corrected visual acuity improved to 1.0 in her right eye.

Conclusion：The present case had some features of IHAPSH：（1）intrapapillary hemorrhage；（2）often occurs in myopia；（3）nasal peripapillary subretinal hemorrhage；（4）the hemorrhage was absorbed spontaneously；（5）good visual acuity；（6）often occurs in woman；（7）seldom recurs；thus, typical IHAPSH was diagnosed. There are few reports of IHAPSH, but it can result in disc hemorrhage at a young age.